NPM: 2: Low-Risk Cesarean Deliveries
Intervention Components (click on component to see a list of all articles that use that intervention): Educational Material (Provider), Educational Material, Media Campaign (Print Materials, Public Address System, Social Media)
Intervention Description: HBWW is a multi-dimensional, community-based approach to preventing preventable preterm births. In HBWW sites, community health leaders, including hospitals, health departments and local March of Dimes staff partner to work together to implement multiple (bundled) interventions known to impact preterm birth; to improve systems of care in their community so that these interventions reach the patients who need them; and to promote awareness of preterm birth across all the community, including providers, patients and the public. The pilot/demonstration project was built on an innovative, ecological model designed to work in real world settings, where a multitude of factors—not a single intervention— influence outcomes. Like other public health problems, prematurity must be addressed in communities with broader approaches than just medical care. Working with providers, the goal of the project was to move research to practice quickly and effectively. With patients, the teams worked to improve networks of support services that addressed patient needs. For the public, the goal was that everyone, whether grandmothers, friends or business leaders, understood the impact of prematurity on families and the community.
Primary Outcomes: N/A
Conclusion: A lesson learned through the HBWW Kentucky pilot is that data has the power to influence behavior and, therefore, directly affect program success. For example, KDMC staff recognized a problem—a substantial number of pregnant women had substance abuse problems, illustrated by the number of newborns with positive toxicology screens. To address this issue, KDMC staff developed a “plan” to appoint a perinatal social worker to address prenatal substance abuse. The site applied for a March of Dimes community chapter grant and received funding for the perinatal social worker position. The social worker’s objectives (the “do” step) included screening women for tobacco, alcohol and drug use during pregnancy; providing appropriate referrals; and providing continuity of care for high-risk prenatal patients by improving communication between the social services department and private physician practices at the hospital. Staff examined toxicology screens at a woman’s entry into prenatal care and at delivery. Once the social worker was established at the site, women with positive toxicology screens at prenatal care enrollment were less likely to deliver infants with positive toxicology screens than prior to the social worker being available. These findings (“study”) and supporting anecdotal evidence encouraged the hospital system to continue funding the social work position beyond the grant funding period. In addition, the social worker was validated and felt empowered to continue work to reduce substance use during pregnancy. Both of these results are part of the “act” stage in PDSA. As new HBWW programs move forward, program staff should share stories and data with partners to celebrate program success. Outcome measurement and process tracking provide program staff with information on accomplishments. Defining measurable objectives for each HBWW core component in a project’s implementation workplan offers opportunities to track success. Although barriers and roadblocks may exist, small and large wins along the way provide reasons to acknowledge and celebrate project successes. Program staff can share these successes with partners, collaborators and the community and thank them for their support through media efforts and during community outreach activities. Each person working on prematurity prevention makes life better for children, their families and the communities in which they live.
Study Design: Ecological Design Study
Significant Findings: Yes
Setting: Pilot Study based in Kentucky.
Data Source: data collected from the state vital records system prior to project implementation and at follow-up
Sample Size: N/A
Age Range: N/A
